Diabetes epidemic in First Nations adults, especially women in prime reproductive years

A diabetes epidemic is affecting First Nations people, especially women in their prime reproductive years, according to a new study in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/embargo/cmaj090846.pdf. The incidence of diabetes was more than 4 times higher in First Nations women compared to non-First Nations women and more than 2.5 times higher in First Nations compared to non-First Nations men.

The study looked at 8275 First Nations and 82 306 non-First Nations cases in Canada's province of Saskatchewan from 1980 to 2005.

Rising rates of diabetes have accompanied an epidemic of obesity that may be associated with the loss of traditional lifestyles. In 1937, diabetes was not detected in a tuberculosis survey of 1500 First Nations people but by 1990, almost 10% of the province's native people had diabetes, a rate that had doubled by 2006 to 20%.

New diabetes cases peaked in First Nations people between ages 40-49 compared with a non-First Nations peak of age 70 plus. First Nations women in particular suffered from diabetes, especially between ages 20-49.

"Diabetes is a disease of young First Nations adults with a marked predilection for women; in contrast, diabetes is a disease of ageing non-First Nations adults that is more common in men," write Dr. Roland Dyck, Royal University Hospital in Saskatoon, Saskatchewan and coauthors.

The authors suggest several reasons for the high rate in women. Higher overweight/obesity rates in First Nations women and high rates of gestational diabetes, a predictor of type 2 diabetes in certain women, may be factors. As well, gestational diabetes is linked to an increase in the risk of type 2 diabetes in children.

These upward trends will likely continue, especially as children and teenagers that make up almost half the First Nations population become adults. The authors urge prevention initiatives targeted to pregnant women, children and young adults to help reduce diabetes rates.

"What is clear is that the rapid appearance of type 2 diabetes particularly among First Nations people and other indigenous and developing populations has been precipitated by environmental rather than genetic factors," state the authors. "Its long term solution will require effective primary prevention initiatives that are population-based and driven by public health and community initiatives."

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